Coronary Artery Disease and Acute Coronary Syndrome

Coronary artery disease is the build-up of atherosclerotic plaque in the arteries that supply the heart muscle, reducing blood flow and causing ischaemia. When a plaque ruptures and a clot suddenly limits coronary flow, the result is an acute coronary syndrome, ranging from unstable angina to myocardial infarction. For nurses, this spectrum underlies much of acute cardiac care, chest-pain assessment, and long-term secondary prevention.

Definition

Coronary artery disease (MeSH descriptor Coronary Artery Disease) is atherosclerotic narrowing of the coronary arteries causing myocardial ischaemia; acute coronary syndrome is the spectrum of acute presentations — unstable angina, non-ST-elevation and ST-elevation myocardial infarction — caused by abrupt reduction in coronary blood flow.

Scope

This topic covers the chronic and acute forms of coronary disease, the mechanism of atherosclerosis and plaque rupture, and the evidence and guidelines that structure care. It addresses the nursing relevance of recognition, monitoring, and secondary prevention in reference terms, without prescribing individualized assessment or treatment.

Core questions

• How does chronic coronary disease differ from an acute coronary syndrome?
• What mechanism links atherosclerosis, plaque rupture, and myocardial infarction?
• How do guidelines frame acute care and long-term secondary prevention?

Key concepts

• Atherosclerosis and plaque formation
• Plaque rupture and thrombosis
• Stable angina versus acute coronary syndrome
• STEMI, NSTEMI, and unstable angina
• Myocardial ischaemia and infarction
• Reperfusion (percutaneous coronary intervention)
• Secondary prevention and cardiac rehabilitation

Mechanisms

Coronary artery disease develops as lipid-laden atherosclerotic plaques accumulate in the coronary vessel wall, progressively narrowing the lumen and limiting blood flow during increased demand, which produces the chest discomfort of stable angina. An acute coronary syndrome occurs when a vulnerable plaque ruptures or erodes, triggering thrombus formation that acutely and severely restricts or occludes coronary flow; the degree and duration of occlusion determine whether the result is unstable angina, non-ST-elevation, or ST-elevation myocardial infarction (Byrne et al., 2023). Sustained ischaemia leads to myocardial cell death (infarction).

Clinical relevance

Coronary disease and its acute syndromes are leading causes of cardiac admission and death, and nursing roles span chest-pain assessment, continuous monitoring, peri-procedural care, and long-term secondary prevention and rehabilitation. This entry describes the condition and its guideline framework for reference and education and is not a basis for individualized diagnosis or treatment.

Epidemiology

Coronary artery disease is one of the most common cardiovascular conditions and a leading global cause of death; chronic coronary disease affects large populations who require ongoing risk-factor management, while acute coronary syndromes account for a major share of emergency cardiac presentations (Virani et al., 2023; Byrne et al., 2023).

Evidence & guidelines

Care is structured by the 2023 ESC guidelines for the management of acute coronary syndromes and the 2023 AHA/ACC multispecialty guideline for chronic coronary disease, which define diagnosis, risk stratification, reperfusion strategies, and secondary prevention, including the patient-education and rehabilitation roles in which nurses participate (Byrne et al., 2023; Virani et al., 2023).

Seminal works

• byrne-2023
• virani-2023

Frequently asked questions

What is the difference between coronary artery disease and acute coronary syndrome?

Coronary artery disease is the chronic atherosclerotic narrowing of the coronary arteries; acute coronary syndrome is the sudden, often plaque-rupture-driven worsening of coronary blood flow that presents as unstable angina or myocardial infarction.

What distinguishes STEMI from NSTEMI?

Both are acute myocardial infarctions, but ST-elevation myocardial infarction (STEMI) shows characteristic ST-segment elevation on the electrocardiogram and typically reflects complete coronary occlusion, whereas non-ST-elevation myocardial infarction (NSTEMI) does not show that pattern; current ESC guidelines describe their differing assessment pathways.